title: Comparison of visual inspection with acetic acid and cervical cytology to detect high-grade cervical neoplasia among HIV-infected women in India.
abstract: Human immunodeficiency virus (HIV)-infected women in India and other developing country settings are living longer on antiretroviral therapy, yet their risk for human papillomavirus (HPV)-induced cervical cancer remains unabated because of lack of cost-effective and accurate secondary prevention methods. Visual inspection after application of dilute acetic acid on the cervix (VIA) has not been adequately studied against the current standard: conventional cervical cytology (Pap smears) among HIV-infected women. We evaluated 303 nonpregnant HIV-infected women in Pune, India, by simultaneous and independent screening with VIA and cervical cytology with disease ascertainment by colposcopy and histopathology. At the cervical intraepithelial neoplasia (CIN2+) disease threshold, the sensitivity, specificity and positive and negative predictive value estimates of VIA were 80, 82.6, 47.6 and 95.4% respectively, compared to 60.5, 59.6, 22.4 and 88.7% for the atypical squamous cells of undetermined significance or severe (ASCUS+) cutoff on cytology, 60.5, 64.6, 24.8 and 89.4% for the low-grade squamous intraepithelial cells or severe (LSIL+) cutoff on cytology and 20.9, 96.0, 50.0 and 86.3% for high-grade squamous intraepithelial lesion or severe (HSIL+) cutoff on cytology. A similar pattern of results was found for women with the presence of carcinogenic HPV-positive CIN2+ disease, as well as for women with CD4+ cell counts <200 and <350 μL(-1) . Overall, VIA performed better than cytology in this study with biologically rigorous endpoints and without verification bias, suggesting that VIA is a practical and useful alternative or adjunctive screening test for HIV-infected women. Implementing VIA-based screening within HIV/acquired immunodeficiency syndrome care programs may provide an easy and practical means of complementing the highly anticipated low-cost HPV-based rapid screening tests in the near future, thereby contributing to improve program effectiveness of screening.
authors.affiliation: Vanderbilt University School of Medicine, Nashville, TN, USA. vikrant.sahasrabuddhe@vanderbilt.edu
authors.forename: Vikrant V
authors.initials: VV
authors.lastname: Sahasrabuddhe
authors.forename: Ramesh A
authors.initials: RA
authors.lastname: Bhosale
authors.forename: Anita N
authors.initials: AN
authors.lastname: Kavatkar
authors.forename: Chandraprabha A
authors.initials: CA
authors.lastname: Nagwanshi
authors.forename: Smita N
authors.initials: SN
authors.lastname: Joshi
authors.forename: Cathy A
authors.initials: CA
authors.lastname: Jenkins
authors.forename: Bryan E
authors.initials: BE
authors.lastname: Shepherd
authors.forename: Rohini S
authors.initials: RS
authors.lastname: Kelkar
authors.forename: Seema
authors.initials: S
authors.lastname: Sahay
authors.forename: Arun R
authors.initials: AR
authors.lastname: Risbud
authors.forename: Sten H
authors.initials: SH
authors.lastname: Vermund
authors.forename: Sanjay M
authors.initials: SM
authors.lastname: Mehendale
mesh_terms: D000085:Acetates; D000328:Adult; D002584:Cervix Uteri / Q000473:pathology*; D003127:Colposcopy; D003430:Cross-Sectional Studies; D003581:Cytodiagnosis; D004279:DNA, Viral / Q000235:genetics; D005260:Female; D006678:HIV / Q000235:genetics / Q000472:pathogenicity; D015658:HIV Infections / Q000150:complications* / Q000821:virology; D006801:Humans; D007194:India; D008403:Mass Screening; D065006:Papanicolaou Test; D016133:Polymerase Chain Reaction; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis / Q000517:prevention & control* / Q000821:virology; D014626:Vaginal Smears; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis / Q000517:prevention & control* / Q000821:virology
chemical_list: D000085:Acetates; D004279:DNA, Viral